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Open AccessCase Report

Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department

1
Endocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania
2
Cardiology Department, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700111 Iasi, Romania
*
Authors to whom correspondence should be addressed.
Diagnostics 2020, 10(5), 316; https://doi.org/10.3390/diagnostics10050316
Received: 7 April 2020 / Revised: 11 May 2020 / Accepted: 14 May 2020 / Published: 18 May 2020
(This article belongs to the Special Issue New Insights in Thyroid Diagnostics)
Despite its’ life-threatening potential due to cardiac severe dysrhythmia in the context of severe hypokalemia, thyrotoxic periodic paralysis (TPP) often goes unrecognized. Although classically confined to young Asian men, it can occur irrespective of age, sex, and race. We report a short series of three cases of TPP as first presentation of Graves’ disease in a young Caucasian male and in two Caucasian elderly and middle-aged women, respectively. The first patient developed malignant ventricular arrhythmias due to severe hypokalemia and was defibrillated, with recovery after prompt potassium correction and administration of antithyroid agents and propranolol. The other two cases developed persistent hypokalemia despite adequate potassium chloride (KCl) repletion, with slow recovery of motor deficit and serum potassium normalization up to day 5. In the first case, long-term euthyroid state was achieved via total thyroidectomy due to the presence of a suspicious nodule that proved to be malignant. In the other two cases, medical treatment was the choice of therapy for thyrotoxicosis. None experienced recurrent TPP. Thyroid hormone evaluation is mandatory in the presence of hypokalemic paralysis, even in the absence of clinical signs of thyrotoxicosis. If TPP is confirmed, initial therapy should comprise antithyroid drugs and propranolol, besides hypokalemia correction. View Full-Text
Keywords: thyrotoxic periodic paralysis; hypokalemia; ventricular arrhythmia; Graves’ disease thyrotoxic periodic paralysis; hypokalemia; ventricular arrhythmia; Graves’ disease
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MDPI and ACS Style

Bilha, S.; Mitu, O.; Teodoriu, L.; Haba, C.; Preda, C. Thyrotoxic Periodic Paralysis—A Misleading Challenge in the Emergency Department. Diagnostics 2020, 10, 316.

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